The Consequences of Surgical Instrument Retention

Surgery is a complex and precise medical procedure that requires meticulous attention to detail, yet errors still occur. Among the most dangerous surgical mistakes is the retention of surgical instruments inside a patient’s body. Known as retained surgical items (RSIs), these objects can include sponges, forceps, retractors, and needles that were mistakenly left behind during an operation.

Retained surgical instruments are classified as “never events”, meaning they should never happen under proper surgical protocols. However, research estimates that RSIs occur in 1 out of every 5,500 to 7,000 surgeries. Some reports suggest that thousands of cases go unreported due to misdiagnoses or a lack of hospital transparency.

The consequences of a retained surgical instrument can be severe, leading to chronic pain, infections, organ damage, and even death. Many patients require additional surgeries to remove the foreign object, further increasing medical risks, hospital bills, and emotional distress. Understanding the risks, prevention methods, and legal implications of retained surgical instruments can help patients advocate for their rights and seek justice if medical negligence has occurred.

What Are Retained Surgical Instruments?

A retained surgical instrument is any foreign object left inside a patient’s body after a surgical procedure. These objects range from small medical tools to larger surgical devices. Some of the most commonly retained items include:

Common Types of Retained Surgical Items

1. Surgical Sponges – Small, absorbent materials used to control bleeding during surgery. These sponges are frequently left behind because they blend into the patient’s tissues and may not be visible to the surgical team.
2. Clamps and Forceps – Metal instruments used to hold tissues in place or control bleeding. These are less commonly retained but can cause serious complications.
3. Needles and Sutures – Small, sharp objects that can be difficult to detect, especially in deep tissue layers.
4. Retractors and Scissors – Large surgical tools that are sometimes forgotten in complex surgeries involving multiple team members.
5. Catheters and Guide Wires – Devices used in minimally invasive procedures, particularly in cardiovascular and gastrointestinal surgeries.

When an object is retained, it can remain undetected for days, months, or even years, leading to severe health complications and requiring additional medical interventions.

How Often Do Retained Surgical Instruments Occur?

Despite strict surgical guidelines, retained surgical items still occur in modern hospitals. According to medical studies:

1. Approximately 1,500 cases of RSIs are reported annually in the United States.
2. The actual number may be higher, as some cases go undiagnosed or unreported.
3. Surgical sponges account for more than 70% of all retained surgical items.
4. Emergency surgeries and obesity-related procedures have a higher risk of RSI due to the increased complexity of the operation.

Given the frequency and severity of these errors, hospitals and surgical teams must adhere to strict protocols to prevent these life-threatening mistakes.

The Risks and Complications of Retained Surgical Instruments

A retained surgical instrument can have catastrophic effects on a patient’s health. The longer an object remains undetected, the more damage it can cause to surrounding tissues and organs.

Health Risks of Retained Surgical Instruments

Severe Infections and Sepsis
Retained instruments harbor bacteria, increasing the risk of postoperative infections. In severe cases, patients can develop sepsis, a life-threatening condition where the body’s immune system attacks itself in response to infection.

Chronic Pain and Inflammation
Many patients experience persistent pain after surgery without knowing that a foreign object is the cause. This can lead to chronic inflammation, affecting mobility and quality of life.

Organ Damage and Internal Bleeding
Metal instruments can puncture or obstruct vital organs, leading to internal bleeding, tissue death, and life-threatening complications.

Bowel and Digestive Blockages
If a sponge or instrument is retained in the abdominal cavity, it may obstruct digestion, causing nausea, vomiting, and severe stomach pain.

Delayed Recovery and Repeat Surgeries
Patients often require corrective surgery to remove the retained item, resulting in additional pain, hospital stays, and financial burden.

How Long Can Retained Surgical Instruments Go Unnoticed?

Many cases of RSI are discovered weeks, months, or even years after surgery. Some patients live with undiagnosed retained objects for decades, only discovering them after experiencing chronic health issues.

Symptoms of an RSI may not appear immediately, making diagnosis difficult. Common signs include:

• Chronic pain at the surgical site
• Unexplained swelling or fever
• Frequent infections that do not respond to antibiotics
• Fatigue and weight loss
• Digestive issues (if the object is in the abdomen)

If you have had surgery and experience these symptoms, it is crucial to seek medical evaluation immediately.

 

How Are Retained Surgical Instruments Diagnosed?

Diagnosing an RSI can be challenging, especially if the object is small or non-metallic. Medical imaging techniques are often used to detect foreign objects inside the body.

Methods for Detecting Retained Surgical Items

1. X-Rays – The most common method for detecting metallic instruments such as clamps, forceps, and needles.
2. CT Scans and MRI – Advanced imaging techniques used to detect soft-tissue abnormalities, including retained sponges and gauze.
3. Ultrasound – Effective for detecting objects in soft tissues and organs.
4. Surgical Exploratory Procedures – In rare cases, if imaging is inconclusive, exploratory surgery may be necessary to locate the object.

 

How Hospitals Prevent Retained Surgical Items

To reduce the risk of RSIs, hospitals and surgical teams follow strict safety protocols. Some of the most effective prevention strategies include:

1. Standardized Instrument Counts

• • Nurses are required to count all surgical instruments before, during, and after surgery.
  • If a discrepancy is found, the patient is not closed until the missing item is located.

2. Radio-Frequency Identification (RFID) and Barcoding Systems

• • Some hospitals use RFID technology to track sponges and instruments.
  • Barcoded sponges can be scanned to ensure nothing is left behind.

3. X-Ray Verification for High-Risk Procedures
   Many hospitals require postoperative X-rays for patients undergoing high-risk surgeries.

4. Surgical Checklists and Improved Communication

• • Hospitals follow the World Health Organization (WHO) surgical safety checklist to reduce errors.
  • Operating room staff are encouraged to speak up if they suspect an item is missing.

 

Legal Implications: Can You Sue for a Retained Surgical Instrument?

If a hospital or surgical team leaves an instrument inside your body, you have the legal right to seek compensation for medical malpractice.

How to Prove Negligence in a Surgical Error Lawsuit
To file a successful malpractice claim, a patient must prove:

1. A doctor-patient relationship existed.
2. The surgeon was negligent in failing to remove all surgical instruments.
3. The retained object caused harm.
4. The patient suffered financial, physical, or emotional damages.

What Compensation Can You Receive?

1. Medical expenses (including corrective surgeries)
2. Lost wages and reduced earning potential
3. Pain and suffering
4. Emotional distress
5. Punitive damages (if gross negligence is proven)

How Long Do You Have to File a Lawsuit?
Each state has a statute of limitations for medical malpractice claims, usually 2 to 4 years from the date of discovery.

 

What to Do If You Suspect a Retained Surgical Instrument

1. Seek medical attention immediately.
2. Request medical records from your hospital.
3. Consult a medical malpractice attorney.
4. File a complaint with the hospital and patient safety organizations.

Frequently Asked Questions About Retained Surgical Instruments

What are retained surgical instruments?
Retained surgical instruments, also known as retained surgical items (RSIs), refer to any foreign object that is accidentally left inside a patient’s body after a surgical procedure. These objects can include surgical sponges, forceps, needles, retractors, and other medical tools used during surgery. RSIs are classified as “never events” because they should never happen under proper medical protocols.

How common is it for surgical instruments to be left inside patients?
Although retained surgical instruments are rare, they still occur at a concerning rate. Studies estimate that RSIs happen in approximately 1 out of every 5,500 to 7,000 surgeries. However, the actual number may be higher due to underreporting. Surgical sponges are the most commonly retained objects, accounting for more than 70% of all RSI cases.

What causes surgical instruments to be left inside patients?
The most common causes of RSIs include errors in surgical tool counting, high-pressure emergency procedures, distractions in the operating room, poor communication among surgical staff, and a lack of technological tracking methods such as RFID tags or barcoded sponges. In some cases, retained instruments occur because of patient-related factors, such as complex anatomy or excessive bleeding that obscures the visibility of surgical tools.

What are the symptoms of a retained surgical instrument?
Symptoms of a retained surgical instrument can vary depending on the type of object and its location in the body. Common symptoms include persistent pain at the surgical site, unexplained swelling or lump formation, chronic infections that do not respond to antibiotics, fever, chills, and fatigue. If the retained object is in the abdominal area, digestive problems such as nausea, vomiting, and bloating may also occur. Some patients may not experience symptoms for months or even years, making diagnosis more difficult.

How can retained surgical instruments be diagnosed?
Retained surgical instruments are usually detected through imaging tests. X-rays are the first-line diagnostic tool for identifying metallic instruments such as forceps and clamps. For non-metallic objects like surgical sponges, CT scans and MRIs provide more detailed imaging. In some cases, ultrasound may be used to detect foreign bodies in soft tissues. If an object remains undiagnosed but symptoms persist, exploratory surgery may be necessary.

 

Contact Matzus Law, LLC Today

If you or a loved one has suffered from a retained surgical instrument, contact us today to schedule a free consultation and to explore your legal options and seek justice.